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More information about what this packet contains:

Patient Information Form - general information about you, including your name, address, etc. This needs to be updated on an annual basis.

Medical Services Contract - a general medical services form allowing us to treat you, which also needs to be signed on an annual basis.

Medical Information Form - a form with questions about the health of your eyes, and your general health. This should be filled out if you are a new patient, or if there are significant changes in your medical condition. Please bring a detailed and updated list of any prescription medications that you take including dosages. Also include a list of non-prescription over-the-counter medications and supplements that you take.

Notice of Privacy Practices - this document discusses how medical information about you may be used and disclosed, and how you can gain access to this information. Read a brief summary about Richmond Eye Associates Privacy Policy at Patient Privacy Notice Summary.

Notice of Privacy Practices Written Acknowledgement Form - this form states that you have been provided a copy of the Richmond Eye Associates Notice of Privacy Practices. You can also create a list of names of individuals that you authorize Richmond Eye Associates to release your personal health information to (including verbal and written discussion). This list could include other physicians or family members.

Medicare Beneficiary Agreement - this form states that Refraction is a non-covered service by Medicare, but that the service can be billed for by Richmond Eye Associates. This agreement needs to be signed on an annual basis.

Insurances and Vision Plans Accepted

Richmond Eye Associates accepts nearly all health insurances and many vision plans, with a few notable exceptions. Nevertheless, the list below is only a partial list, and it is highly likely that your insurance IS accepted by us. Contact our billing office at 804-270-0330 if you have any concerns or questions about the plans we cover prior to you examination.

While Richmond Eye Associates will gladly file insurance claims for patients, it is ultimately the responsibility of the patient to determine from their own insurance company if the examination will be a covered service, and if any copays or deductibles will be required.

Last Updated 1/2014
Note that with some insurances only physicians are covered, and in some cases only optometrists are covered, and in some cases both are covered. The Richmond Eye Optical shops do not participate with all of the plans listed below. Call 804-270-0330 for specific details about our acceptance of your insurance.

Vision Plans Accepted by Drs. Lumpkin and Koza, optometrists (O.D.)

Vision Service Plan

Davis Vision

Eyemed / Blueview Vision

Before Your Appointment Checklist

If you have an appointment with a Richmond Eye Associates doctor, review the following checklist:

Determine whether or not your individual insurance policy covers eye examinations, and whether or not a referral or authorization for the examination is required. Many primary care physician offices require 24 to 48 hours in advance to generate an insurance referral, and in most cases referrals will not be generated retroactively.

Please note that a consultation request from your medical doctor to see a doctor of Richmond Eye Associates' is separate from an Insurance Referral Authorization.

If you have an insurance authorization for an eye examination, make sure that the appointment is scheduled within the required time frame (usually 30 to 90 days).

If you are a new patient, feel free to download and print these New Patient Forms to be filled out ahead of time. Bring them to your appointment:

Insurance Copays, Medicare/Insurance Deductible amounts, and Refraction Fees and other Non-Covered Services are due at the time of service.

If you do not medical or vision coverage, payment will be due at the time of service. Call the business office at 804-270-0330 to determine what the expected fee will be, and to arrange a payment plan if necessary.

Please note that failure to provide 24 hours of notice of appointment cancellation may result in $40 cancellation charge.

Be sure to bring your current glasses, contact lenses, and contact lens information (manufacturer boxes or packages) with you for your exam.

"Routine" vs. "Medical" Examinations

Most health insurances divide eye examinations into two categories:

1. Routine Eye Examination

This is a complete eye examination which is covered once every 1 to 3 years, depending on the insurance.

The purpose of this examination is to establish that the eyes and visual system are healthy, and a glasses or contact lens prescription may be determined. "Refraction Fees" and contact lens fitting fees are often considered separate services and have separate charges.

In "routine" examinations, there is usually no other ocular diagnosis or problem except those relating to a glasses prescription (nearsighted, farsighted, etc.)

Vision Plans and some Medical Insurance Plans offer coverage for Routine Eye Examinations. It is the patient's responsibility to know their specific benefits.

Note that Medicare does not cover "routine" eye examinations, but in many cases a medical diagnosis can be used (see below).

2. Medical Eye Examination

A "Medical Eye Examination" is performed when there is either a medical diagnosis of the eyes or visual system themselves (such cataract, glaucoma, retinal problems, conjunctivitis, dry eye, etc.), or there is an overall medical diagnosis which might affect the eyes (such diabetes, hypertension, etc.).

Furthermore, an eye examination can be considered "medical" if it is in follow-up of a previously diagnosed condition.

Medical Eye Examinations may require a written insurance authorization from a "gate keeper" medical physician prior to the eye examination. A glasses or contact lens prescription may be obtained during this examination as well, although this considered a separate service with a separate fee.

What if I have both a Vision Plan and Medical Insurance?

In this case, the Vision Plan can be used if the examination is intended to be a Routine Eye Examination as described above. However, if there is a chance that the examination may be medical, it is better to obtain an referral / authorization, if required by your insurance company, in advance. Note that eye examinations performed because of a medical condition such as diabetes should always be considered medical, because services may be required (such as fundus photography) that fall outside of the scope of a routine eye examination.

Non-covered Services

Refraction

Refraction is defined as the determination of a glasses or contact lens prescription through the use different trial lenses or other techniques. Medicare, and many other major insurance companies, have separated the "refraction" out from the rest of the eye examination. Instead of covering the refraction, these insurances request that the physicians themselves collect the "refraction fee" as a non-covered, but billable, service.

Some Vision plans and Medical Insurances may cover the "refraction fee", but many do not

The "refraction fee" is due at the time of the visit, and is currently $35 (subject to change).

A refraction fee is usually charged when the determination of a glasses or contact lens prescription is made. In some cases there might not be a change in the prescription, but the determination of the prescription is made nevertheless as confirmation. In most cases, a glasses or contact lens prescription is dispensed at the time of refraction. However in some cases a refraction may be performed in order to determine the best corrected vision, but the prescription is not dispensed because of medical reasons (cataract requiring surgery, etc.)

Advance Beneficiary Notice

In some cases it may not be likely that Medicare or an insurance company will cover a particular service. This may be because the service is a new diagnostic procedure or treatment that has not been fully reviewed by the insurance. In many cases insurances will not cover office procedures considered to be cosmetic. If it is possible that the insurance may not cover the test or procedure, you will be informed of this and will be given the Advance Beneficiary Notice to review and sign.

Medicare Specific Issues

Accepting Assignment to Medicare

Richmond Eye Associates accepts assignment to Medicare, which means that we accept the payments for services that Medicare allows. Medicare pays 80% of this allowed amount for a service, and the patient is then responsible for the additional 20%. This may be paid by a secondary insurance. By accepting assignment, we agree to NOT bill the patient for more than the allowed amount defined by Medicare for the service. We have no control over what payment values Medicare places on office and surgical services. Refraction (the determination of a glasses prescription) and non-covered services are exceptions of where Medicare allows billing of the patient for a service that they do not cover.

Medicare Coverage of Glasses After Cataract Surgery

Medicare may help with the cost of spectacles (lenses and/or frames) one time after cataract surgery has been performed. The patient must have Medicare coverage when the surgery is performed to be covered.

Medicare does not cover 100% of the cost. Instead, 80% of the Medicare "allowable" charge is covered. The patient will be responsible for any amount that Medicare does not cover.